Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Melissa Rosales

Rancho Cordova,CA

Summary

Challenging position applying my knowledge and skills. Gaining work experience with the potential to develop a career.

Overview

17
17
years of professional experience

Work History

Medical Office Service Coordinator III Lead

UC Davis Medical Center
06.2023 - Current
  • Experience and knowledge of practices and protocols related to medical office procedures, (i.e. medical terminology, appointments, medical records, insurance verification, cashiering, billing, etc.)
  • MOSC 3 experience
  • Demonstrated leadership skills that reflect the ability to serve as the coordinator of a specified unit of workers. Must be able to represent assigned unit serving as subject matter expert and resource person for the staff.
  • Ability to efficiently use computer system applications for all functions required for this position, including electronic mail, spreadsheets, word processing, and medical office management, (i.e. scheduling, template maintenance, maintenance of demographic and insurance information).
  • Writing skills, using proper English grammar, spelling and punctuation, sufficient to compose messages and/or routine correspondence, which is clear, concise, and easy to understand.
  • Filing skills to maintain logs and files of information in alphabetical, chronological and/or numerical order, such that it is current and easily retrievable. Knowledge of all pertinent laws, regulations, and guidelines governing medical records; confidentiality, privacy, and provision to others, including HIPAA.
  • Knowledge of health care insurance systems, which may include Medi-Cal, MediCare, HMO, PPO, fee-for-service, county funded coverage, and workers’ compensation, sufficient to properly obtain and track authorizations, appoint patients, make referrals for consults, diagnostics, and ancillary services, coordinate hospital services, complete and submit billing documentation, and explain provisions and requirements to patients.
  • Knowledge of ICD-9, CPT and HCPCS coding sufficient to identify services performed, including diagnoses, procedures, and supplies.
  • Lead or call center experience.
  • Oncology experience

Medical Office Service Coordinator III (Neurology)

UC Davis Medical Center
02.2021 - 06.2023
  • MOSC 2 experience
  • Experience with referrals, authorizations, and scheduling.
  • Experience with Epic and EMR.
  • PC proficiency in using multiple computer system applications.
  • Experience answering a high volume of calls and execute requests in a timely manner.
  • Knowledge of practices and protocols related to medical office procedures, (i.e. medical terminology, appointments, medical records, insurance verification, cashiering, billing, etc.).
  • Knowledge of health care insurance systems, which may include Medi-Cal, Medicare, HMO, PPO, fee-for-service, county-funded coverage, and workers’ compensation, sufficient to properly obtain and track authorizations, appoint patients, make referrals for consults, diagnostics, and ancillary services, coordinate hospital services, complete and submit billing documentation, and explain provisions and requirements to patients.
  • Knowledge of ICD-9, CPT, and HCPCS coding guidelines sufficient to accurately identify services performed, including diagnoses, procedures, and supplies.
  • Neurology experience

Agricultural Technician I

Department of Food and Agriculture
03.2018 - Current
  • Maintain updates to the Plant Quarantine Manual for online use by field staff and counties.
  • Provides assistance in the preparation of form letters to counties, other state regulatory officials, USDA, and the general public.
  • Gathers information on various plant pest topics such as identification, distribution, and damage or symptoms on hosts.
  • Preview the online Federal Register for topics pertinent to Pest Exclusion and forward to appropriate professional staff.
  • Input data from applications for Phytosanitary Field Inspections into an MS Access database.
  • Compile and edit information submitted by the counties at the request of the Interior Pest Exclusion Program.
  • Develop reporting structure for county data collection for Sudden Oak Death or other pests and programs.
  • Verified and submitted timekeeping information for accurate and efficient payroll processing.
  • Performed calculations in overtime, vacation and sick hours to provide accurate data to payroll processing database.
  • Use computer equipment and programs such as Microsoft Word, Adobe, Acrobat, Access, and Excel.
  • Provided clerical support to CDFA employees by copying, faxing and filing documents.

Network Management Rep II

Anthem Blue Cross
08.2015 - 09.2017
  • Develops and maintains positive relationships with the hospital and physician community by periodic on-site visits, communicating administrative or programmatic changes and facilitating the resolution of issues.
  • Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
  • Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
  • Conducts seminars to support the understanding of managed care, policies and procedures.
  • Identifies network access and deficiencies and develops recruitment and contracting strategies.
  • Coordinates and conducts training.

Customer Service Rep II

Health Net Federal Services
10.2012 - 08.2015
  • Help providers and beneficiaries with questions in regards to Tricare.
  • Process authorizations/referrals for beneficiaries/providers, RAOC.
  • CPT/ICD-9/ Medical Terminology knowledge.
  • Able to read and interpret claims and EOB's.
  • PC3 trained for medical documents pre-sorting for VA.
  • Effectively managed a high-volume of inbound and outbound customer calls.
  • Addressed and resolved customer product complaints empathetically and professionally.
  • Accurately documented, researched and resolved customer service issues.
  • Met or exceeded service and quality standards every review period.
  • Solved unresolved customer issues.
  • Investigated and resolved customer inquiries and complaints in an empathetic manner.

Customer Solutions Rep III

EDS
01.2008 - 01.2011
  • Help providers and beneficiaries with billing/claims, and any other issues they have.
  • Assist with Medi-Cal line as well as with reimbursement department.
  • Assist with Oklahoma Health Choice insurance line.
  • Managed customer calls effectively and efficiently in a complex, fast-paced, and challenging call center environment.
  • Improved call center functionality and service capacity by resolving customer complaints efficiently and quickly.

Head Technician

Flextronics/Solectron
05.2006 - 10.2007
  • Arranged for repair and replacement of defective items covered by warranty.
  • Kept records of services in progress.
  • Notified customers when service was completed and accepted payments.
  • Assisted customers to select and purchased specified merchandise.
  • Supervised employees, scheduled work hours, resolved conflicts, and determined salaries.
  • Answered customer's telephone, mail, and in-person inquiries and directed customers to theappropriate sales area.
  • Managed call flow and responded to technical support needs of customers.
  • Resolved problems with malfunctioning products.
  • Activated accounts for clients interested in new services.

Education

High School Diploma -

Central Union High School
El Centro, CA
05.2005

Associate of Arts - Health Care Administration

University of Phoenix
Sacramento, CA
09.2012

Skills

  • Bilingual (Spanish)
  • Strong in MS Access and Excel
  • Microsoft Outlook, Word, and Excel
  • Insurance eligibility
  • Medical terminology knowledge
  • HIPAA compliance
  • Local/state health laws knowledge
  • Familiar with commercial and private insurance carriers
  • Understands insurance benefits
  • Patient referrals expert
  • Knowledge of Medicaid statutes and regulations

Languages

Fluent in Spanish

Timeline

Medical Office Service Coordinator III Lead

UC Davis Medical Center
06.2023 - Current

Medical Office Service Coordinator III (Neurology)

UC Davis Medical Center
02.2021 - 06.2023

Agricultural Technician I

Department of Food and Agriculture
03.2018 - Current

Network Management Rep II

Anthem Blue Cross
08.2015 - 09.2017

Customer Service Rep II

Health Net Federal Services
10.2012 - 08.2015

Customer Solutions Rep III

EDS
01.2008 - 01.2011

Head Technician

Flextronics/Solectron
05.2006 - 10.2007

High School Diploma -

Central Union High School

Associate of Arts - Health Care Administration

University of Phoenix

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Melissa Rosales